The advent of multileaf collimators in 90s and the ever increasing access to fast computers laid the foundation for a radical change in the practice of radiation therapy. Advanced technology emerged together with numerous conceptual and technical ramifications in treatment calculation and delivery. Merged with imaging, advanced radiotherapy in developed countries has become much resource-intensive, team-based and complex; nevertheless, it is now the new norm.

Modern treatment technology is inevitably – though not comprehensively– finding its way to the clinics of many developing countries, where the industrial work culture and technical network has not yet flourished as much. In developing countries, especially where private practice is allowed, there is a vibe towards purchasing fancier technologies to get a lead against other radiotherapy centers and potentially attract more patients as a result of selling the prestige of the new technology.

Yet as:- the technical support is not always adequate,- the necessity for training and teamwork has not been fully acknowledged,- the intricacies of the technology is overlooked and,- the culture of optimizing workflow and considering human factors has not formed well, modern technology may not be used as optimally as in developed countries and may not result in comparable outcomes. When misused, novel technologies can even do more harm than good to patients. This conference aims at bringing professionals together to confer about such issues and suggest ideas to form an atmosphere of debate and discussion for the clinicians, investors, managers and equipment vendors.

Whether you are a radiation oncologist or a clinical medical physicist, a manager or investor, or just an enthusiastic equipment provider who seeks alternative approaches to the market of a developing country, we invite you to participate and contribute to the discussions of this conference, sharing your novel ideas or experiences to pin down major objectives in defining pathways for ameliorating advanced radiotherapy functionality in situations where resources are more limited than a fully developed country.

The conference is programmed by ISCO, in scientific collaboration with ESTRO and benefits from a world-class faculty in the field of radiation oncology. To seek contributions from international community and to set the ground for broader discussions and collaborations the official language of the conference is English. International attendees with an interest in the subject of this conference are welcome. ISCO can help obtaining visas and legal clearances for international participants.

Welcome

Foreword

Dear Colleagues,

It is my great pleasure to welcome you at the ‘PARIMICs’ conference in Tehran, where we gather, as responsible care providers, to think together on how to ameliorate the quality of our services to our patients. As the entrance of modern therapy machines has accelerated into our clinics, it has been a while since we first felt the need to address new situations created by the modern technology. Although the lag in our educational system, in our clinics workflow, in our regulations and in our ability to optimally use modern technology is obvious, we have not yet clearly identified specific issues in each area and have not yet started to think of potential common policies to reduce or resolve them individually. This conference is our first attempt at the international level to clarify specific concerns that advanced radiotherapy technology brings along into developing middle income countries (MICs). The situation for MICs is special, in that they are potentially capable of purchasing advanced machines, but are not capable of using them optimally as in developed countries. Lack of infrastructure and awareness about technology are potentially important contributing factors to the suboptimal implementation of modern therapy technology. I would like to cordially welcome and thank our scientific faculty members whose work to prepare content for this conference has been rigorous and valuable. I wish all participants a rewarding conference both at a personal and at the professional level. This is a good opportunity for our national professionals to participate in a world-class event and raise the standards of their practice, form mutual collaborating groups, refine and ameliorate their knowledge and skills, learn new concepts and get in touch with colleagues from other nationalities and with a set of different experiences at their work place. We wish every participant a gainful participation and easy stay in Tehran.

As the second mortality cause within the human population, half of all cancer incidences happen in low and middle-income countries (LMICs). While treatment of cancer with radiation can be highly cost-effective, strive for implementing efficient treatments in LMICs faces demanding challenges. Correct use of radiotherapy technology in high income countries improves treatment outcome and reduces complications; however, correct and efficient use of the same technology in LMICs is challenged by manifold limitations.As commerce grows, advanced radiotherapy technology gradually finds its way into the clinics of many middle-income countries (MICs) and the trend is growing even when public access to basic radiotherapy equipment is still limited by either lack of infrastructure or imbalanced distribution of treatment facilities. While the purchase of advanced technology may primarily fulfill a commercial cause rather than a prime clinical exigency, its proper use and implementation is a real clinical necessity. Mastering proper practice with advanced treatment technology requires critical thinking and rigorous technical training, both of which may have been overlooked in MICs; i.e., the technology has arrived and been implemented while the required prowess lags behind. This should raise concerns about patient’s safety and treatment efficiency in such situations.The Iranian Society of Clinical Oncology, in collaboration with ESTRO and IAEA, is holding a three-day conference to look over concerns of improper implementation of advanced therapy technology and to create a field of debate for evaluating the current situation with advanced technologies in MICs in general, and in Iran in particular. The conference also includes related educational content for medical professionals in radiotherapy. A number of pioneer specialists from across the globe will discuss necessities and prerequisites of advanced radiotherapy treatments and will deliver educational materials on different links of the treatment chain. Moreover, broader issues related to the problems of MICs in absorption and implementation of the technology will be discussed. The conference contains more than 50 lectures, talks and panel discussions together with contouring workshops for radiation oncology professionals and physics workshops for clinical medical physicists, supervised by ESTRO school preceptors.